What Is Insomnia?And What Is CBT-I?

It’s 2:40 a.m. and you’ve done the math three times: if you fall asleep right now, you’ll get four hours. The clock shows another minute gone. You dread tomorrow’s meeting, and the dread keeps you awake, and the lack of sleep makes you dread the next night. You started doing this in March.

What it looks like

The NHS¹ lists trouble falling asleep, waking several times in the night, daytime tiredness and trouble concentrating. The NHLBI² adds daytime sleepiness and effects on memory and concentration. See trouble falling asleep and waking at 3 a.m..

What causes it

The NHLBI² says short-term insomnia is usually caused by stress or changes in your schedule or environment. The NHS¹ lists stress, anxiety or depression, noise and temperature, alcohol, caffeine and nicotine, sleep disorders such as sleep apnoea, and medical conditions such as thyroid disorders and menopause. See sleep apnea in women and hot flashes.

Why it’s worth treating

The NHLBI² says chronic insomnia raises the risk of serious conditions, including high blood pressure, coronary heart disease, diabetes and cancer, so it recommends seeing a provider if sleep problems last several weeks. For what else poor sleep is linked to, see how much sleep you need.

CBT-I, the preferred first treatment

The NHLBI³ says cognitive behavioral therapy for insomnia, or CBT-I, is the preferred initial treatment for long-term insomnia. It’s a 6 to 8 week program with five parts:

• Cognitive therapy to reduce anxiety about sleep.
• Relaxation or meditation techniques.
• Sleep education, including good sleep habits.
• Sleep restriction, which strengthens the link between the sleep and wake cycle.
• Stimulus control, which relinks the bed with sleep.

The NHS¹ says CBT, available face-to-face or online, helps change the thoughts and behaviors that keep you from sleeping. It suggests going to bed only when you’re sleepy, getting up at the same time every day, and avoiding screens before bed because the blue light makes you more awake.

What about sleeping pills and supplements

The NHS¹ says GPs now rarely prescribe sleeping pills, keep them for severe cases, and prescribe them for a few days, or weeks at the most, because of the risk of dependency. The NHLBI³ lists prescription options and says over-the-counter antihistamine products need a physician’s input. It says research hasn’t established that melatonin works for insomnia. See melatonin.

The play

Try this: a sleep diary, then a first step

For two weeks, write down when you got into bed, when you fell asleep, how often you woke, when you got up and how you felt. Add caffeine, alcohol and screen time.

Take the diary to your clinician and ask about CBT-I, which can be done face to face or online.

In the meantime, use the NHS’s¹ basics: go to bed when you’re sleepy, get up at the same time daily and keep screens out of the last stretch of the evening.

When to get checked

The NHS¹ says to see a GP if changing your sleeping habits hasn’t helped your insomnia, or if symptoms persist for months and affect daily functioning. The NHLBI² says to consult a provider if sleep problems persist for several weeks.

Book an appointment if any of these fit:

• Trouble sleeping has lasted several weeks
• It happens 3 or more nights a week
• Daytime tiredness is affecting work, mood or safety
• You’ve changed your habits and nothing has helped
• You’re using alcohol or over-the-counter pills to get to sleep
• You snore or wake gasping, or you’re going through menopause

Insomnia that’s lasted since March has a treatment, and the treatment is a program you can finish. Ask for it by name.